Anna's Story

Anna, age 11, has Cerebral Palsy and a learning disability. She is undergoing planned surgery for a scoliosis of the thoracic spine. She has some verbal communication but is difficult to understand for those unused to her speech. She uses an individually molded support in her wheelchair. During her stay on the ward her parents are planning to be with her during the day but not at night. The present plan is that he/she will return to school after a week of convalescence at home. 

Stages in the Patient's Journey

Stage 1

Pre-op visit
  • Understanding the needs of the individual child to develop a care plan with the family. Include pain recognition and management.
  • Reassurance to minimise anxiety - Links between anxiety and pain experience.
  • Manual handling assessment.

Relevant Professional Groups
  • ODP
  • Nursing - Child
  • Speech and language therapist
(Great Ormond Street http://www.gosh.nhs.uk/medical-conditions/clinicalspecialists/orthopaedic-and-spinal-surgery-information-for-parents-and-visitors/clinics-and-wards/ - Videos, specialism services descriptions etc.)
  • Physiotherapy 
  • Occupational therapy

Relevant Issues and Theories 
  • Pain profiles
  • Pain information and communication records. 
  • Capacity, consent and rights of the child
  • Pain experience and anxiety
  • Diagnostic overshadowing 
  • Assessment of positioning, moving and handling for safety and comfort

Assessment interventions and evaluation
  • Risk and safety
  • Communication including pain communication
  • Reassurance 
  • Exchange of information between family and staff
       - Arrangements pre-op  -  starving etc.
       - Post op pain management 
       - Care regime
       - Sitting and lying support requirements 
       - Swallow (SALT report?)
  • Developing a plan of care
  • Child's previous experience of pain and discomfort
  • Assessing muscle tone, rom and positioning
  • Planning post-surgery
  • Level of independence and daily function
  • Moving and handling needs
Stage 2 

Post OP

Relevant Professional Groups
  • All
  • Nursing
  • Play Specialist 
  • Physiotherapy
  • Occupational Therapy

Relevant Issues and Theories
  • Communication 
  • Understanding tone and reflexes 
  • Analgesia, wound care
  • Nursing care
  • Activity and role of distraction in pain management 
  • Respiratory care
  • Positioning for comfort and function Pressure and skin integrity
  • Liaison and transition

Assessment interventions and evaluation
  • After care
  • Posture in lying and sitting
  • Positioning for comfort and maintenance of function
  • Skin integrity
  • Discharging planning - continuity of care and liaison with local social care and wheelchair services
Stage 3

Care following Discharge


Relevant Professional Groups 
  • Community Nursing
  • Physiotherapist 
  • Occupational Therapist - Social Care 
  • Wheelchair services - OT and Physio

Relevant Issues and Theories
  • Team work 
  • Wound care
  • Mobility 
  • Pressure care
  • Manual handling and transfers - safety and comfort
  • Function and comfort

Assessment interventions and evaluation
  • Removal of dressing
  • Analgesia
  • Mobility and passive
  • Development of a revised 24 hour seating and lying plan post-op for skin integrity comfort and function
  • Wheelchair adaption short term and long term re-designed for support, skin integrity and comfort in function
About this Resource:
This resource has been developed by the Faculty of Health and Social Sciences at Bournemouth University (BU) and funded by the BU Centre for Excellence in Learning. The contents have been developed and co-created by staff and students from BU. The site was designed by Thomas Galloway & Abraham Weiskorn, a Graphic Design Student from Portsmouth University and a Digital Media Design Student from Bournemouth University. The editors are: Dr Carol Clark Senior Academic - Physiotherapy and Dr Desi Tait Senior Academic - Nursing from Bournemouth University.

The aim of this site is to promote and facilitate inter-professional learning and collaboration in the theory and practice of pain management using a humanising approach to care (Todres et al 2009).